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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies
Youichi Yasui, Laura Ramponi, Dexter Seow, Eoghan T Hurley, Wataru Miyamoto, Yoshiharu Shimozono, John G Kennedy
Youichi Yasui, 2nd Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
Youichi Yasui, Laura Ramponi, Dexter Seow, Eoghan T Hurley, Wataru Miyamoto, Yoshiharu Shimozono, John G Kennedy, Hospital for Special Surgery, New York, NY 10021, United States
Laura Ramponi, 2nd Rizzoli Orthopaedic Institute, Bologna 4136, Italy
Dexter Seow, Eoghan T Hurley, 2nd Royal College of Surgeons in Ireland, Dublin 2, Ireland
Wataru Miyamoto, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8606, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Kennedy JG is a consultant for Arteriocyte, Inc.; has received research support from the Ohnell Family Foundation, Mr. and Mrs. Michael J Levitt, and Arteriocyte Inc.; is a board member for the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Cartilage Repair of the Ankle, American Orthopaedic Foot and Ankle Society Awards and Scholarships Committee, International Cartilage Repair Society finance board.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author “insert email”, who will provide a permanent, citable and open-access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Youichi Yasui, MD, 2
nd Department of Orthopaedic Surgery, Teikyo University School of Medicine, 1-1 Kaga, 2-Chome, Itabashi-Ku, Tokyo 173-8606, Japan.
youichi@med.teikyo-u.ac.jp
Telephone: +81-3-39644097 Fax: +81-3-53756864
Received: January 29, 2017
Peer-review started: February 13, 2017
First decision: May 10, 2017
Revised: July 29, 2017
Accepted: August 15, 2017
Article in press: August 16, 2017
Published online: December 18, 2017
Processing time: 322 Days and 16.7 Hours
AIM
To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).
METHODS
Two reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.
RESULTS
This review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.
CONCLUSION
The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.
Core tip: Bone marrow stimulation (BMS) is a reparative procedure for osteochondral lesions of the talus, promising approximately 85% success rates in the short- and mid-term. To date, the prognostic factors for BMS are lesion size and containment of the lesion. No other factors have been shown to be universal predictors. However, the level of evidence and methodological quality of evidence for clinical studies accompanying both the lesion sizes and containment are low. Overall, 95.5% of the studies included in the analysis are level IV or level III. No level I study was identified. The methodological qualities of the included studies were not strong. In particular, the scores of “primarily evaluates outcome criteria and recruitment rates” were low.
